How clinically effective is intravascular ultrasound in interventional cardiology? Present and future perspectives

Abstract

Intravascular ultrasound (IVUS) has been clinically available for almost 25 years now and showed us valuable information regarding the coronary vessel lumen, its dimensions, the plaque burden and plaque characteristics that we were not able to assess by angiography alone. Using these abilities, IVUS has helped us to start, understand the atherosclerotic process in the coronary vessels. Further technical innovations partially overcame the somewhat limited image resolution of IVUS allowing more in-depth characterization and quantification of coronary plaque components. In addition, IVUS has been shown to be helpful to guide interventional procedures including optimal stent deployment in many clinical situations. In this review, we focus on the potential role of IVUS technology in interventional cardiology and on the valuable role of IVUS usage in percutaneous coronary interventions.

Use of Intravascular Ultrasound in the Assessment of Chronic Total Occlusions

“…A second guidewire can then be advanced alongside the IVUS catheter. 13,14 The use of IVUS also facilitates a wiring technique based on the fact that CTOs are often found distal to a branch artery. The IVUS catheter can be placed into a side branch just proximal to the CTO, allowing the proximal cap and central lumen of the CTO to be visualised.…”

“…The retrograde wire can then be manipulated from the distal vessel position, which can be intimal or subintimal, into the true lumen and beyond the occluded segment. 14 Most experts agree that IVUS guidance improves the quality and outcomes of PCI. However, its use has been limited by a lack of appropriately powered randomised trials to provide robust evidence of the benefits of IVUS-guided PCI on clinical outcomes.…”

Intravascular ultrasound as an adjunct tool for angiographically intermediate lesions and complex coronary interventions: patient selection and perspectives

“…2 When it was first developed in the 1970s, the initial role of IVUS was to evaluate plaques in atherosclerotic coronary arteries. 3 With the development of automatic lesion analysis software and enhanced imaging of metallic stent struts, the application of IVUS was further extended to guide successful coronary stent implantation. 3 Currently, IVUS can accurately identify plaque burden, morphology, and characteristics.…”

“…3 With the development of automatic lesion analysis software and enhanced imaging of metallic stent struts, the application of IVUS was further extended to guide successful coronary stent implantation. 3 Currently, IVUS can accurately identify plaque burden, morphology, and characteristics. As IVUS quantification of coronary stenosis has fewer anatomic limitations than angiography, it can be especially useful when angiographic diameter stenosis is considered indeterminate or unreliable.…”

“…5 IVUS is also helpful during PCI to evaluate stent sizing, expansion, apposition, and edge dissection. 3 After PCI, it can be used to determine the cause of stent failure, including in-stent restenosis and stent thrombosis (ST). 6 Most experts agree that IVUS guidance improves the quality and outcomes of PCI.…”